A Functional Medicine Protocol for Gastritis

Gastritis is very common. In the U.S., acute gastritis affects eight out of every 1,000 people. Globally, as much as half of the population has chronic gastritis. (25) 

Those who have it understand that this medical condition's persistently uncomfortable symptoms can be physically and emotionally draining. Fortunately, a comprehensive medical evaluation and targeted healing therapies can help reduce inflammation, heal the stomach lining, and prevent unwanted health complications. 

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What Is Gastritis?

Gastritis is inflammation of the stomach lining. This lining (called mucosa) usually protects the stomach's tissues from everyday insults, such as acidic digestive enzymes and bacteria. For various reasons, this mucosal barrier may begin to break down and become inflamed. 

Types of Gastritis

Gastritis can be classified based on its duration, histological features, and etiology.

Gastritis can be acute or chronic (25):

• Acute gastritis occurs suddenly and is temporary.
• Chronic gastritis appears gradually over time and causes long-term symptoms. 

Gastritis can be erosive or non-erosive (25):

• Erosive gastritis is characterized by superficial erosion (ulceration) of the stomach lining.
• Non-erosive gastritis is characterized by inflammation of the stomach lining without visible erosions or ulcerations.

Finally, gastritis can be classified more specifically based on the underlying cause of inflammation. Examples include:

• Infectious gastritis
• Drug-induced gastritis
• Alcohol-induced gastritis
• Stress-induced gastritis
• Autoimmune gastritis
• Eosinophilic gastritis (25)

Gastritis Signs & Symptoms

Gastritis symptoms can vary in severity. Some people may not experience any symptoms. If symptoms do occur, they most commonly include: 

• Indigestion: gnawing or burning upper abdominal pain
• Nausea 
• Vomiting
• Loss of appetite or a feeling of fullness soon after eating
• Bloating
• Bleching and hiccups (23, 24) 

Vomiting blood, having blood in your stools, or having black stools are signs of bleeding ulcers. If this occurs, seek medical care right away. (24) 

Root Causes of Gastritis

Gastritis can be caused by various factors that disrupt the stomach's protective lining, leading to inflammation. 

One of the most common causes is infection with the bacterium Helicobacter pylori (H. pylori), which can lead to chronic inflammation and, if left untreated, may progress to ulcers or stomach cancer. Other pathogens linked to infectious gastritis include syphilis, cytomegalovirus (CMV), herpes simplex virus (HSV), parasites, and Candida. 

Certain diet and lifestyle habits can irritate the stomach lining, increase acid production, and inhibit the production of protective mucus. These include: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
• Excessive alcohol consumption
• Smoking
• Chronic stress

Autoimmune gastritis occurs when the body's immune system mistakenly attacks the cells of the stomach lining, specifically the parietal cells, which are responsible for producing stomach acid and intrinsic factor. The exact cause of this autoimmune response is not entirely understood, but it is believed to involve a combination of genetic predisposition and environmental triggers. Individuals with a family or personal history of autoimmune diseases, such as type 1 diabetes, Addison's disease, and Hashimoto's thyroiditis, are at higher risk.

Other medical conditions can also cause gastritis, including:

• Bile acid reflux: the backwards movement of bile from the small intestine into the stomach
• Pernicious anemia: a type of anemia caused by the inability to absorb vitamin B12 due to a deficiency of intrinsic factor.

How to Diagnose Gastritis

Although a patient's medical history and laboratory tests can provide valuable insights into disease etiology, endoscopy and biopsy remain the gold standard for diagnosing gastritis and determining its severity. Therefore, any patients experiencing gastritis symptoms should schedule an appointment to be evaluated by a healthcare professional.

Step 1: Initial Testing

The following laboratory tests are appropriate to order during the initial evaluation of suspected gastritis:

• Complete blood count (CBC) to screen for anemia
• Comprehensive metabolic panel (CMP) to screen for electrolyte imbalances and liver/gallbladder dysfunction
• Serum lipase and amylase to rule out pancreatitis (if suspected based on clinical intake)
• Fecal occult blood test (FOBT) to rule out gastrointestinal (GI) bleeding

Step 2: Endoscopy

An upper endoscopy is a procedure that involves inserting an endoscope (a flexible scope with a camera) into the upper digestive tract to visualize the stomach lining and assess for signs of inflammation. Small tissue samples may be biopsied during the procedure to be evaluated under a microscope to diagnose gastritis and determine its cause. (19) 

Doctors can order an upper GI series (barium swallow) as a less invasive alternative to endoscopy. During this test, the patient drinks a chalky liquid called barium while doctors take a series of x-rays to visualize the upper GI tract. (19) 

Step 3: Tests to Personalize Gastritis Treatment Plans

These are some of the labs that can be most helpful in determining the root causes and consequences of gastritis:

H. pylori Testing

All patients with gastritis should be tested for H. pylori infection by endoscopy (if performed), stool antigen, or urea breath testing. These H. pylori stool tests are available to order through Rupa Health: 

• H. Pylori Antigen by Doctor's Data
• H. Pylori by Diagnostic Solutions

Food Allergy & Sensitivity Testing

Eliminating inflammatory foods from the diet is a common strategy in treating gastritis. Therefore, ordering a test that screens for food allergies and sensitivities is often a priority so that dietary eliminations can be customized to the patient's specific needs. 

These are all excellent test options to consider: 

• Food Allergy and Sensitivity Testing (FAST 88 Foods: IgE/IgG4 & IgG) by Infinite Allergy Labs
• 96 IgG Food Sensitivity & 15 Common IgE Combo Panel by Alletess Medical Laboratory
• IgE Allergy Explorer & IgG Food Explorer Combo by Diagnostic Solutions

Stress Testing

Salivary cortisol is a non-invasive measure of hypothalamic-pituitary-adrenal (HPA) axis function and is a biomarker for the human stress response. Elevations in salivary cortisol or irregular secretory patterns indicate chronic stress may be an underlying cause of gastritis.

• Adrenal Stress Profile by ZRT Laboratory
• Salivary Cortisol x 4 by Access Med Labs
• Adrenal Stress Panel by Ayumetrix

Micronutrient Testing

Damage to the stomach lining in chronic gastritis can impair the absorption of nutrients, especially iron, vitamin B12, calcium, magnesium, and zinc. A micronutrient panel is an all-in-one testing method to screen for deficiencies that can lead to additional diseases (such as anemia), perpetuate inflammation, and inhibit GI healing. 

These panels are popular options available at Rupa Health: 

• Micronutrient Test by SpectraCell
• Cellular Micronutrient Assay by Cell Science Systems 
• NutrEva FMV by Genova Diagnostics

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Treatment Plan for Gastritis

Gastritis treatment will depend on the specific underlying causes, but all treatment protocols should focus on removing noxious stimuli, reducing inflammation, and promoting gastric healing.

Step 1: Remove Inflammatory Triggers

Here's Why This Is Important:

Removing the inflammatory trigger directly addresses the root cause of the inflammation, allowing the stomach lining to begin healing and alleviating the patient's symptoms.

How Do You Do This?

Eradication of H. pylori is required for anyone infected with this bacteria with symptomatic gastritis. Refer to Rupa Magazine's H. pylori Protocol article for details on accomplishing this. To summarize, antimicrobial therapy should be initiated with conventional antibiotic therapy (such as the triple therapy or bismuth quadruple therapy regimens) or with multiple evidence-based natural antimicrobials, such as: 

• Mastic gum 1-2 grams daily (in split doses)
• Bismuth subsalicylate 525 mg four times daily
• Berberine 500 mg twice daily

Patients should be advised to discontinue their intake of all NSAIDs, tobacco products, and alcohol. 

Processed sugars, coffee, spicy foods, acidic foods, fried foods, and salty foods are common dietary triggers for gastritis.

Elimination diets can be considered for patients who report an improvement of symptoms with food avoidance, those with elevated eosinophils on gastric biopsy, or those who are not improving despite other therapies. In general, it is recommended that food sensitivities should be removed from the diet for at least four weeks. After that time, foods can be reintroduced into the diet one at a time with a three-day food rechallenge as patients observe for recurrence of gastritis symptoms.  

Chronic stress induces gastritis by activating the sympathetic nervous system, which disrupts normal digestive processes and impairs the stomach's protective barrier. Research shows that reducing stress through mind-body practices like meditation and tai chi for one hour three times a week has a strong curative effect on chronic gastritis.

Step 2: Reduce Inflammation

Why Is This Important?

This step is an extension of the first, bringing on board anti-inflammatory and immunomodulating agents that can expedite the resolution of gastritis. 

How Do You Do This?

Following an anti-inflammatory diet can help reduce systemic inflammation. An anti-inflammatory diet revolves around eating whole, unprocessed fruits, vegetables, whole grains, beans, lean proteins, healthy fats, herbs, and spices. Following these tips can help you make the transition to an anti-inflammatory diet: 

• Eat: colorful fruits and vegetables, whole grains, fatty fish, extra virgin olive oil, nuts, seeds, herbs, and spices (38) 
• Limit/Reduce: processed snack foods, fried foods, refined grains, soda, and processed meats (39) 

Probiotics exhibit immunomodulating effects through various mechanisms and can strengthen the gut barrier. Research has shown that fermented milk with live probiotic cultures benefits patients with infectious gastritis by enhancing the efficacy of H. pylori eradication therapy, reducing mucosal inflammation, and preventing damage to the mucosa. 

N-acetylcysteine (NAC) is a potent antioxidant that can reduce inflammation. In one clinical trial, doses between 1 and 4 grams daily effectively improved symptoms and inflammation related to chronic atrophic gastritis. 

Marshmallow root has been used medicinally for thousands of years because of its anti-inflammatory and healing properties. This herb's polysaccharide constituents form a gel-like substance called mucilage, which can soothe inflamed tissues and stimulate tissue regeneration. Standard dosing recommendations call for taking 6 grams of powdered root daily in divided doses.

Step 3: Promote Gastric Healing

Why Is This Important? 

Reestablishing a healthy and intact gastric mucosal layer prevents the recurrence of gastritis.

How Do You Do This?

Many evidence-based remedies have been shown to reduce GI inflammation and heal gastric ulcers.

Cabbage is rich in antioxidants, such as vitamin C and sulforaphane, L-glutamine, and methionine S-methyl sulfonium (MMS), which act together to reduce inflammation and heal the gut lining. Older studies suggest drinking one liter of cabbage juice daily can help heal stomach ulcers, although it's important to note that insufficient follow-up research supports this claim.

Licorice, specifically its deglycyrrhizinated form called DGL, is an effective adjunct in H. pylori eradication protocols. It also helps heal the GI lining by increasing blood flow to the affected area and stimulating mucus-producing cells. DGL, given in doses of 760-1,520 mg between or 20 minutes before meals, effectively treats stomach ulcers. 

Zinc carnosine was initially developed in Japan in the 1990s to treat stomach ulcers. In addition to its anti-inflammatory and antioxidant properties, which contribute to these healing properties, studies have also shown that adding zinc carnosine (dosed 75 mg twice daily) to triple antibiotic therapy is superior to triple antibiotic therapy alone for treating H. pylori infection.

Step 4: Correct Nutritional Deficiencies

Why Is This Important?

Certain types of gastritis, namely H. pylori gastritis and autoimmune gastritis, can cause problems absorbing nutrients from food, especially iron and vitamin B12 (20). Iron and B12 deficiencies can cause anemia, leading to symptoms like fatigue and weakness. 

‍How To Do This

Oral replacement of identified deficient vitamins and minerals should be initiated, especially if dietary restrictions prevent adequate daily intake through diet alone. Doses, duration, and route of administration should be recommended based on the severity of deficiency. 

Patients with pernicious anemia will require life-long treatment with intramuscular or oral cobalamin.

The Risks of Untreated Gastritis

Untreated gastritis can lead to several complications, some of which can be severe. 

One major complication is the development of peptic ulcer disease, which is the formation of sores on the stomach lining. These ulcers can cause significant pain and may lead to bleeding, perforation, and infection. 

Chronic gastritis can result in atrophic gastritis, where the stomach lining becomes thinned and loses its function. This condition increases the risk of gastric cancer due to the potential for intestinal metaplasia, a precancerous change in the stomach lining. 

Gastritis Case Study

If you want to keep learning about gastritis and how to treat it, read this case study:

Diane Had Mysterious Gut Problems That Wouldn't Get Better. Here's How She Found Relief

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Key Takeaways:

• Gastritis is a common condition that can occur due to lifestyle factors, infection, and other underlying diseases. 
• Accurate diagnosis with laboratory tests and endoscopy can determine the root cause of stomach inflammation. From there, a comprehensive treatment protocol that focuses on removing triggers, reducing inflammation, and healing the gut can resolve gastritis and its potential burden on general wellness.